NCC220721_FRO Submitted_20220210

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity covered by Chapter 17, Article 2 of the Charlotte City Code or Section
6 of the Mecklenburg County Sedimentation and Erosion Control Ordinance prior to completing and fling this form with
the City of Charlotte Engineering and Property Management Department, Land Development Services Division or
Mecklenburg County Land Development Services. The financial responsibility party will be on record as the party to accept
any Notices of Violation or related documents for any non-compliance of the City of Charlotte Soil Erosion and
Sedimentation Ordinance. if the financially responsible party is out of State, a North Carolina agent must be assigned.
Please Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken: Beachntont Tosvithomes
2. Address of land --disturbing activity; 1721 Parker .Drive, Lots 140 —148 (Bldgs 25 - 27)
3. Approximate date land -disturbing activity will commence; Feb. 2022
WIWI Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Townhonte Construction
5. Approximate acreage of land to be disturbed or uncovered; 0.43
6. List total site acreage: 20.6 ae.
7. Landowners of Record (Use blank page to list additional owners);
Name (1) : Parker Town Home Lots LLC
Address: 136 Main Street
Pineville, NC 28134
Telephone; 704 363-1368 Fax: NIA
(Area Code) (Area Code)
Email Address; strsan(a),-vestcapitahcom (Strsart Rosenblatt)
Signature: SeeAuthori ation Letter rout Owner
Name (2):
Address:
Telephone:
(Area Code)
Email Address:
Signature:
Fax:
(Area Code)
8. Indicate Book and Page where deed or instrument is Bled (Use blank page to list additional deeds or
instruments) Book 34881 Page 383 Book Page
Book Page Book Page
Page t

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: NVR, Inc. Nba Rvan Homes
Address:_ .. 10710 Sikes Place, Suite 250
Charlotte NC28277
Telephone:_ _ (704) 815--3500 _Fax: N/A
(Area Code) (Area Code)
Email Address: ._bsegnl nLyL tyrinc.eom (Bro(fie Scanlin)
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: Corporation Service Cortman
Address: _26.26 Glenwood Avenue, Suite 550
Raleigh. NC 27608
Telephone: [phone] Fax: N/A
(Area Code) (Area Code)
Email Address: N/A
3. The above information is true and correct to the best of my knowledge and belief and was provided by me
while under oath. (This form must be signed by the financially responsible person if an individual or by an
officer, director, partner, attorney -in -fact, or other person with authority to execute instruments for the
jimpoially responsible company or entity, if not an individual.)
Mnathhn Hess
Vice President
Title
1. A @,J - iem
Date
_ — Y I I N rplfylq' a Notary Public of the County
Of UM 0 V1 . State of t\A U OV G" U n CU hereby
eert� that b y) a'th av% C f W S _personally
appeared before me this day and under oath acknowledge that this form was executed by lairs/her°.
PKitness nay hand and notarial seal, this (� day of _ J 20 2 _7'
Notary Signature:
My Commission expires
0 -1- 25
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Land Development Division
600 East: Fourth Street, Charlotte, North Carolina 28202-2844
Telephone:[phone] Fax: [phone]
http://landpermits.cliarmeck.org
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